17
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective:

          To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data.

          Methods:

          We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted.

          Results:

          Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities.

          Conclusion:

          Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

          Related collections

          Most cited references 70

          • Record: found
          • Abstract: not found
          • Article: not found

          Geriatric Depression Scale.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Antidepressant use and risk of adverse outcomes in older people: population based cohort study

            Objectives To investigate the association between antidepressant treatment and risk of several potential adverse outcomes in older people with depression and to examine risks by class of antidepressant, duration of use, and dose. Design Cohort study of people aged 65 and over diagnosed as having depression. Setting 570 general practices in the United Kingdom supplying data to the QResearch primary care database. Participants 60 746 patients diagnosed as having a new episode of depression between the ages of 65 and 100 years from 1 January 1996 to 31 December 2007 and followed up until 31 December 2008. Main outcome measures Hazard ratios associated with antidepressant use for all cause mortality, attempted suicide/self harm, myocardial infarction, stroke/transient ischaemic attack, falls, fractures, upper gastrointestinal bleeding, epilepsy/seizures, road traffic accidents, adverse drug reactions, and hyponatraemia, adjusted for a range of potential confounding variables. Hazard ratios were calculated for antidepressant class (tricyclic and related antidepressants, selective serotonin reuptake inhibitors, other antidepressants), dose, and duration of use and for commonly prescribed individual drugs. Results 54 038 (89.0%) patients received at least one prescription for an antidepressant during follow-up. A total of 1 398 359 antidepressant prescriptions were issued: 764 659 (54.7%) for selective serotonin reuptake inhibitors, 442 192 (31.6%) for tricyclic antidepressants, 2203 (0.2%) for monoamine oxidase inhibitors, and 189 305 (13.5%) for the group of other antidepressants. The associations with the adverse outcomes differed significantly between the antidepressant classes for seven outcomes. Selective serotonin reuptake inhibitors were associated with the highest adjusted hazard ratios for falls (1.66, 95% confidence interval 1.58 to 1.73) and hyponatraemia (1.52, 1.33 to 1.75) compared with when antidepressants were not being used. The group of other antidepressants was associated with the highest adjusted hazard ratios for all cause mortality (1.66, 1.56 to 1.77), attempted suicide/self harm (5.16, 3.90 to 6.83), stroke/transient ischaemic attack (1.37, 1.22 to 1.55), fracture (1.64, 1.46 to 1.84), and epilepsy/seizures (2.24, 1.60 to 3.15), compared with when antidepressants were not being used. Tricyclic antidepressants did not have the highest hazard ratio for any of the outcomes. Significantly different associations also existed between the individual drugs for the same seven outcomes; trazodone (tricyclic antidepressant), mirtazapine, and venlafaxine (both in the group of other antidepressants) were associated with the highest rates for some of these outcomes. Absolute risks over 1 year for all cause mortality were 7.04% for patients while not taking antidepressants, 8.12% for those taking tricyclic antidepressants, 10.61% for selective serotonin reuptake inhibitors, and 11.43% for other antidepressants. Conclusions Selective serotonin reuptake inhibitors and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with tricyclic antidepressants. Among individual drugs, trazodone, mirtazapine, and venlafaxine were associated with the highest risks for some outcomes. As this is an observational study, it is susceptible to confounding by indication, channelling bias, and residual confounding, so differences in characteristics between patients prescribed different antidepressant drugs that could account for some of the associations between the drugs and the adverse outcomes may remain. Further research is needed to confirm these findings, but the risks and benefits of different antidepressants should be carefully evaluated when these drugs are prescribed to older people.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              The file drawer problem and tolerance for null results.

                Bookmark

                Author and article information

                Journal
                Braz J Psychiatry
                Braz J Psychiatry
                bjp
                Brazilian Journal of Psychiatry
                Associação Brasileira de Psiquiatria
                1516-4446
                1809-452X
                18 July 2016
                2016
                : 38
                : 3
                : 247-254
                Affiliations
                [1 ]Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
                [2 ]Programa de Pós-Graduação em Ciências Médicas, Psiquiatria, UFRGS, Porto Alegre, RS, Brazil
                [3 ]Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
                [4 ]Z.org Leuven, University of Leuven, Kortenberg, Belgium
                [5 ]School of Psychiatry, University of New South Wales, Sydney, Australia
                [6 ]Ingham Institute for Applied Medical Research, Liverpool, Australia
                [7 ]Charles Perkins Centre, School of Public Health, University of Sydney, Sydney, Australia
                [8 ]Geriatrics Section, Department of Medicine, Università degli Studi di Padova, Padova, Italy
                [9 ]ULSS 17 Mental Health Department, Department of Neurosciences, Università degli Studi di Padova, Padova, Italy
                [10 ]Departamento de Educação Física, UFRGS, Porto Alegre, RS, Brazil
                [11 ]Department of Physiotherapy, South London and Maudsley NHS Foundation Trust, London, United Kingdom
                [12 ]Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
                Author notes
                Correspondence: Felipe B. Schuch, Rua Dionélio Machado, 23, CEP 90040-060, Porto Alegre, RS, Brazil. E-mail: felipe.schuch@ 123456ufrgs.br
                Article
                10.1590/1516-4446-2016-1915
                7194268
                27611903

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Review Article

                Comments

                Comment on this article

                Similar content 133

                Cited by 38

                Most referenced authors 1,743